Inspection on 28/11/05 for Hornegarth House Nursing Home

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hornegarth House Nursing Home 28/11/07

Hornegarth House Nursing Home 13/07/06

Hornegarth House Nursing Home 28/06/05

Hornegarth House Nursing Home 21/02/05

Hornegarth House Nursing Home 21/09/04

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hornegarth House Nursing Home 204 Walsall Road Great Wyrley Walsall West Midlands WS6 6NQ Lead Inspector Mrs Joanna Wooller Announced Inspection 28th November 2005 09:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hornegarth House Nursing Home Address 204 Walsall Road Great Wyrley Walsall West Midlands WS6 6NQ 01922 701702 01922 411115 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Southern Cross Care Homes Limited Care Home 45 Category(ies) of Dementia (45), Dementia - over 65 years of age registration, with number (10), Mental disorder, excluding learning of places disability or dementia (45) Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 45 Dementia (DE) - Minimum age 60 years on admission Date of last inspection 28th June 2005 Brief Description of the Service: Hornegarth House offers nursing care to 42 service users with mental health problems and long-term mental illness. The home has 38 bedrooms with ensuite facilities. There are 34 single bedrooms and four double bedrooms. The home promotes and encourages community involvement. The home is situated within a thriving village, on a bus route between Walsall and Cannock. It is within easy walking distance of the main Stafford to Birmingham railway line. This purpose built home has wide corridors and ramps for easy access by wheelchair users. The home is on two levels and has access via stairs or a passenger lift. There are two lounges, a dining room and a conservatory. A secure garden is planted out with bushes and shrubs. Many recreational and diversional activities are carried out daily. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this announced visit on Monday 28th November 2005. The inspection was completed using the National Minimum Standards for Older People as a reference. The total time spent for the inspection, including pre and fieldwork, amounted to six hours. The newly appointed manager was in the home. Working in the care environment were two registered nurses and six care assistants. The ancillary staff on duty included; the cook, a catering assistant, three housekeepers, one laundry person, the activity coordinator and the administrator. These staffing levels were adequate to meet the needs of the current 41 nursing and three residential residents in the home. The inspection included the following elements; a tour of the building, observation and inspection of records relating to provision of care, discussions with several residents, discussions with all the staff members on duty, observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, quality assurance and health & safety. It was evident that aspects of care were being addressed, with service users and their relatives able to choose the home following an assessment and invitation to visit the home. Resident plans had been well written and included health; personal and social care needs, which were generally well documented. Privacy, dignity and choice aspects for residents were being upheld. The home was fit for purpose and provided a safe environment for the residents and staff. A very homely atmosphere had been created, and the premises were generally clean, warm and tidy with the exception of two bedrooms. Adequate areas for residents were provided including; communal space, dining/activity space, bathing/toilet facilities, and bedrooms. Services and facilities, including catering and laundry, were adequately provided. Health and safety aspects had been given a high priority. Recruitment and retention of staff aspects were good with little staff turnover. Staff training had started to be given priority, with induction training being followed by NVQ training, and some staff had received supervision. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 6 General management aspects were good with company quality assurance taking place. Records had been correctly filed and stored. Assurances were given regarding the positive financial viability of the home, and that suitable accounting/business procedures are adopted. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Each resident has a pre admission assessments completed by the manager or a senior nurse this ensures that there individual need will be met. Relatives or representatives of the prospective resident are fully informed as part of the preadmission process that their individual needs can be met. EVIDENCE: Each service user had been assessed prior to admission. Multidisciplinary involvement was evident in most care records. Any special needs of the individual including cultural, social and personal needs are fully discussed and documented. This assessment initiates the process of care, each individual having a plan of care, which includes a daily living plan and longerterm goals and outcomes. Relatives and representatives are included in the preadmission assessments to ensure needs are identified and documented. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 9 Pre admission visits are arranged as necessary. In line with Regulation 14 (1d) the home will confirm in writing to the service user or their next of kin, that the home will be able to meet the individuals assessed needs. This is arranged for the next admission. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 8, 10 and 11 The individually assessed health and personal care needs of each resident had been well documented as being met, with good standards of care being delivered. There was a safe system for the receipt, storage, administration and disposal of medicines monitored by in house audits. There was evidence that service users were treated with respect, privacy and dignity, during the caring process. EVIDENCE: The service user plans and documentation was well written, meaningful and reflected the current condition of residents. The documentation seen evidenced that health and personal care needs were being well met. A transitional phase is evident at present with a new recording system being introduced NHS facilities and professionals including community nurses, medical consultants and clinical nurse specialists had all been accessed when required, and these events were seen recorded. A local GP practice and a local Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 11 pharmacist (8pm Chemist) service the home. Pharmacy issues are being reviewed at present. Records of their visits and outcomes were seen documented. It was observed that a safe system of medication administration and disposal was in place, and that the comprehensive medicines policy documentation seen was being complied with. The documentation seen evidenced that only trained nurses administered medicines. During the inspection it was again possible to observe that privacy and dignity were being afforded to residents, and there was very good interaction with staff. Care staff knocked on doors before entering. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 and 15. The lifestyle provided by the home appeared to be meeting the needs of the residents, and links with family were being observed. The diet of residents was being provided in line with their choices and/or assessed needs. EVIDENCE: All staff were observed re-assuring residents. The Snoezelen room had been reinstated ad the room was being used for defusing aggression, frustration, and agitation in confused residents. The activity organiser was in the home with one to one and group activities arranged. Plans for Christmas were well underway. Notice boards were full of residents’ photographs at events and planned activities were displayed. All visitors are welcomed into the home to support the residents in their daily life. The Vicar visits the home at least monthly. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 13 Meals are provided form a well-run kitchen with no outstanding environmental health issues. Seasonal changes add variety to the menus. The care staff assists some residents who require support whilst feeding. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 to 18 The complaints procedure was in place and this was visible to all visitors to the home. Legal rights for residents are considered and staff are trained appropriately to ensure residents are protected from abuse. EVIDENCE: Southern Cross healthcare policies, procedures and relevant documentation are now place at the home. The complaints record was displayed. The commission had been informed of no complaints since the last inspection and one had been received in the home. Staff are fully aware of the different types of abuse and have been trained to look for signs and symptoms of abuse. Residents’ legal rights are protected and documented. Advocacy services are available for residents with no relatives or representatives. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 25 and 26 The refurbishment had continued in the home. Residents’ rooms were personalised and generally comfortable. The residents live in a safe environment which checks being made by the manager. The home was generally clean and tidy in most areas, with exception of two bedrooms. EVIDENCE: Externally the home was presented well maintained including the gardens. Internally, the home was showing signs of improvement with the refurbishment slowly underway. The Snoezelen room was in full working order again and well equipped. The hairdressing salon/activities room was reorganised and the nursing office had been recited off one of the lounges. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 16 The ancillary staff were working hard to ensure the environment was of a good clean standard. The cleaning products they showed me they were satisfied with and they were aware of the bedrooms the inspector had identified. With the exception of two bedrooms as identified on this visit the cleanliness of the home was of a good standard. In one room a carpet did smell of urine, but the deputy manager assured the inspectors that this had been subject to a heavy program of deep cleaning without the desired results, and she was advised to ensure that it was replaced with a suitable alternative means of flooring. This had been identified at previous inspections. The other bedroom was extremely malodorous and required immediate attention. Bedrooms were well personalised and safely arranged. Necessary equipment was available for individuals who require assistance. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 28 The assessed needs of service users had again been met by an adequate number of suitably trained staff. Recruitment procedures had been followed which had contributed to the protection of service users. Staff training was documented. EVIDENCE: Staffing levels were being maintained as at 1st April 2002 and following a discussion with the staff it was again agreed that the shift cover was adequate. There are two registered nurses on duty 8am to 8pm in addition to the minimum of six care staff on each morning shift and five care assistants on each evening shift. Three carers on duty during 8pm to 8am support one registered nurse. Adequate ancillary staff had been provided each week. The new manager to give the team of staff some stability and to avoid issues of off duty arising had introduced a three weekly rota. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 18 The home adheres to robust recruitment policies and procedures. Staff had been subject to POVA/CRB comprehensive checks, and these were recorded. Training had been provided for staff in the awareness and management of dementia related conditions along with adequate statutory training. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 36, 37 and 38. The home appeared to be well managed. Appropriate quality assurance was required to be in place. Financial aspects were correctly addressed and recorded with safeguards to residents. Health and safety issues had been given a high priority and managed well. EVIDENCE: The newly appointed manager is yet to be registered with the CSCI (Stafford office). She has completed the Registered Manager Award. Although not in the post very long she has started to display some positive changed throughout the home. She wishes to recruit more registered nurses with an interest in mental health to balance the skill mix. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 20 Through company supervision she has to provide an action plan for the home with targets to reach. Quality audits are completed with monthly area manager visits (Reg.26) and a validation audit follows. Medication, care records and accident audits also have to be completed. Financially the home showed no obvious signs of problems. Residents’ moneys were handled in house appropriately and advocacy services were available. Staff supervision has commenced with the National Minimum Standards being used as a base line. A new induction pack procedure and documentation has been introduced in to the home for new staff. Several staff have recently completed a three day Health and Safety Course. Thirty staff is first aid trained in the home and food hygiene updates are continuous. Fire safety training was in order. Health and safety checks of equipment and systems within the home were evidenced to be in order. Several problems with the lift have continued to be a major problem in the home and this is to be replaced in the New Year. Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 X X 3 3 X 3 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X 3 X 3 3 3 Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 16 (2k) Requirement Malodorous rooms must be addressed immediately. Timescale for action 28/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hornegarth House Nursing Home DS0000022342.V271417.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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